Community Regional Medical Center
Community Regional Medical Center is licensed for 626 inpatient beds and is home to all of the UCSF Fresno residency programs. It is the 5th largest and 3rd busiest hospital in the state. The new Trauma/Critical Care Building includes a 56,000 square foot, 70-bed emergency department as well as state of the art Burn unit, critical care units, cardiac cath lab, and two 64-slice CT scanners (one in the ED). The annual ED census is over 110,000, making it the 3rd busiest in California.
CRMC is the only Level 1 Trauma Center serving a several county area of Central California. It is a major teaching institution with approximately eighty full-time faculty physicians and a housestaff of 180. In addition to emergency medicine, there are approved residency training programs in: internal medicine, surgery, obstetrics and gynecology, pediatrics, family medicine, psychiatry, oralmaxillofacial surgery, orthopaedic surgery and dentistry. We currently have fellowships in pulmonary critical care, cardiology, infectious disease, palliative care, gastroenterology, acute care surgery, surgery critical care, minimally invasive surgery, wilderness medicine and EM ultrasound.
All attending physicians affiliated with the residencies are UCSF faculty. A UCSF Medical School Associate Dean is based at the UCSF Center for Medical Education and Research which also houses local UCSF Fresno staff, departmental offices, the medical library, an auditorium, multiple conference rooms, and a medical simulation lab.
CRMC’s ED contains three major trauma rooms with dedicated CT and radiology services, a 10-bed cardiac/critical care pod, an 11-bed major medical area, a 25-bed minor treatment area, fast-track, ophthalmology and ENT rooms, several family rooms, a 4-bed cast and suture suite, 3 ED ultrasound machines, a law enforcement area, a sexual assault center, a secure behavioral care unit, offices, a conference room, clerical and nursing support space, dedicated laboratory and respiratory services, a paramedic and parkmedic communication base station, and 2 helicopter landing pads, among other services and facilities.
The emergency medicine residents and staff are responsible for the initial evaluation and treatment of the majority of ED patients. Midlevel providers help staff the lower acuity Green Zone and fast track area which is open 24 hours a day. Academic and non academic EM clinicians also see patients primarily. Emergency medicine residents also staff these areas and all medical care there is supervised by attending physicians. All patients and visitors are screened by dedicated security personnel stationed in the ED.
Most critically ill and injured patients in Fresno are brought to CRMC. Blunt trauma victims outnumber penetrating trauma victims (80% & 20% respectively). Pediatric trauma patients are transported to either CRMC or Children’s Hospital of Central California. Frequently, those suffering a mishap in the surrounding mountain and rural areas are transported to us via helicopter – either by the Skylife aeromedical personnel or by the California Highway Patrol.
CRMC is a paramedic and parkmedic communication base station handling thousands of emergency medical systems radio calls monthly. MICN’s and emergency medicine residents and faculty direct prehospital care via protocol over the radio. The Department of Emergency Medicine is actively involved in training and supervising paramedics and parkmedics and our residents play a substantial role in this process. Members of our faculty serve as medical directors for the Fresno County and Madera/King Counties EMS systems, the Sequoia/Kings Canyon Parkmedic Program and the local helicopter and ambulance services.
Other major teaching and patient care facilities include: a burn unit, a coronary care unit, a surgical ICU, a medical ICU, a dialysis center, a hyperbaric chamber, and an acute psychiatric intervention center. Consultative support is continuously available from: surgery and all its subspecialties, oromaxillofacial surgery, dentistry, obstetrics and gynecology, pediatrics, internal medicine, family medicine, cardiology, ophthalmology, neurology, gastroenterology, and radiology.
Ancillary support—from RN’s and LVN’s, technicians, aides, clerks, social workers and others—is excellent. Physicians do not start peripheral IV’s, do EKG’s, pass nasogastric tubes, etc
CRMC serves the population of Fresno County and its surrounding areas. Our patient population is culturally diverse and reflective of the area’s population as a whole with approximately 90 different ethnic groups represented. About 50% of our patients are Hispanic, and approximately 10% speak only Spanish. Interpreters and interpreting services are available on an ongoing basis to assist in the care of all patients.
Valley Children’s Hospital, located in Madera, is a tertiary care hospital for children in the San Joaquin Valley. Last year, they cared for over 98K children in their ED, making it one of the busiest children’s hospital in the country. Currently, our PGY2s spend two months in the ED caring for children under the supervision of board certified pediatric EM specialists. During their 1st month, they also spend time in the operating room performing airway management under the supervision of pediatric anesthesiologists.
St. Agnes Medical Center is a local private hospital with 18,000 admissions and 75,000 ED visits/year. Specialized services include advanced interventional cardiology and cardiac surgery, a breast imaging center, and an area wide hospice for both adults and children. The Emergency Department is staffed by residency trained, board certified Emergency Physicians. Emergency residents spend one month during the PGY-4 year in the St. Agnes Hospital emergency department. SAMC has recently opened a new expansion, which includes additional cath labs, radiology services, and a new state of the art ED.
Kaiser Permanente Fresno
Kaiser Permanente Fresno officially became a new site in August 2015. Kaiser Fresno’s ED currently has 35K visits/year with an admission rate of 15%. Residents are supervised by board certified emergency medicine residency trained emergency physicians, many of whom trained at UCSF Fresno. Three of the clinical faculty each have over 25 years of experience supervising and educating emergency medicine residents. The rotation offers a clinical experience in a fully integrated closed system health care delivery model that continues to grow and flourish in California.